HPV and cervical cytology

Infection with high-risk human papillomaviruses (HPV) is the major risk factor for the development of cervical neoplasia. It is therefore reasonable to propose that the identification of these viruses may be helpful in the context of cervical screening. High-risk HPV infection is strongly associated with cervical neoplasia, particularly if persistent and present in women over the age of 35 years. Therefore, tests for HPV in the context of cervical cytology only need to identify high-risk HPV types. The strengths of HPV testing are high sensitivity and negative predictive value, indicating that the absence of HPV may be of more clinical value than its presence. However, the clinical application of HPV testing should be evaluated in the context of specific populations. HPV testing may have a role in: (i) primary screening; (ii) the assessment of women with mildly abnormal smears; (iii) post-treatment follow-up; and (iv) quality control of cervical cytology. HPV vaccination, if implemented, is likely to alter the epidemiological characteristics of HPV infection and cervical neoplasia. The effects of vaccination on HPV prevalence, HPV-type distribution and HPV-associated neoplasia will need to be monitored closely.